Health Pearls in the Time of Coronavirus: Message to Our Pregnant Patients

You are pregnant, and the fear of Coronavirus is keeping you up at night.  There has yet not been enough research on COVID-19 in pregnant patients, so fear is understandable.  Below is helpful information for you from the American College of Obstetrics and Gynecology. www.ACOG.org  As more studies are done, this information may change over time.

• Pregnant women do not have more severe symptoms with than the general public and can use the same precautions to avoid Coronavirus infection: washing hands with soap and water for 20 seconds or more, avoid touching the face, using hand sanitizers with at least 60% alcohol, avoiding sick people, staying at least 6 feet away from others in public, or staying home as much as possible , common sense advice that you have heard many times by now. 
• Should you wear masks? Not necessarily if you are healthy.  However, wear one if you feel sick, or taking care of someone with symptoms of  COVID-19.  Some people, however, still prefer wearing masks for the sole purpose of helping them to avoid touching their face. 
• Keep yourself healthy!  Exercise, eat healthy foods, and sleep well.  Do not let social distancing lead to unhealthy weight gain and affect your baby poorly.  Remember obesity  and unhealthy weight gain can increase your risk of diabetes in pregnancy, which in itself can lower your immune system.  Sleeping well, exercising, and mindfullness practice  can lower your stress hormones and help you maintain calm during this crisis
• How often should you have prenatal visits? Discuss with your obstetricians about how much you should space out your routine prenatal visits.  Many well known institutions have agreed that many visits can be done through telemedicine.  The more critical in-office visits might be limited to the initial visit with genetic testing (11-12 weeks ), anatomy scan (20 weeks), third trimester lab screening including diabetes testing (26-28 weeks), Group B strep screening ( 36 weeks) and a visit at 39 week, right before your due date.  If you have high risk conditions such as hypertension, diabetes, or poorly controlled thyroid disorders, you might need more in-person visits.  The spacing out of visits is to protect you and your baby from unnecessary risk of Coronavirus exposure.  Ask your doctors about telemedicine.
• What if you have symptoms of COVID-19? Call your obstetrician or primary care doctor.  They will manage you the same way the general public is treated.  If you have severe symptoms of COVID-19 such as shortness of breath or chest pressure, confusion, blue lips or skin, you will need to call 911 or go to an Emergency Room.
• What If you are pregnant and have COVID-19? You will be managed by your physician the same way as other COVID-19 patients. With mild symptoms you will remain at home, separating yourself physically from your loved ones, wearing a mask, avoiding public settings and transportation, and calling 911 in case of worsening  symptoms.
• Where to give birth: NOT at home, as home birth has 20% higher mortality rate.  Hospital, or certified birth centers are still the SAFEST PLACES to give birth.  Do not let fear of COVID-19 lead you to making decisions that could negatively impact your life and your baby’s life!
• Can COVID-19 pass through breast milk? There is no evidence yet, and breastfeeding is important to boost your baby’s immune system, so please breastfeed your baby. 
• Do you have to stop breastfeeding or separate from your baby if you have COVID-19 symptoms or are diagnosed with COVID-19? Not necessary, follow the CDC website for cleaning your breast pump, wear a mask and wash your hands before breast feeding.
• When should you come back to see your obstetrician after your delivery? With an uncomplicated vaginal delivery, during this COVID-19 social distancing time, and if you are stable, many academic institutions believe you should come back 8-12 weeks later.  If you have a Cesarean section, you might be able to have a telemedicine visit two weeks after delivery and show your obstetrician your incision through the computer camera.  Of course, if you have signs of infection such as tenderness or inflammation, you should call your obstetrician to have an in-office visit to evaluate your incision.

If you have more questions, go to the CDC website for further (and the most up-to-date) recommendations or call your doctors. Do not let fear and anxiety rob you of this special time in your life.  Keep a diary and photos of what you have done during your time of “shelter in place.” Someday, you will be able to share what you did to prepare for your child’s arrival, and protect him or her in the new and different world.

From Dr. Bindeman:

If you are pregnant and nearing delivery, stay in contact with your care team as things continue to be in flux. So far,  the virus does not seem to be transmitted through the placenta. To minimize potential contact with the virus, many hospitals are restricting the number of people that can be in the birthing room with the laboring person. If your Plan A is not able to work, this is the time (prior to the onset of labor) to start to think about a Plan B and Plan C for labor. Can you have virtual support from a doula or family? (make sure that you pack your charger for your phone and perhaps a charging block as well!) What comfort objects, or smells can you bring? (essential oils are great for this).

**Photo: USS Comfort in NY Harbor this morning, bringing 1,000 hospital beds for patients with non-Covid-19 issues, courtesy of my friend John McClave.Tags: